Elevated baseline glomerular filtration rate (GFR) is independently associated with a more rapid decline in renal function of patients with type 1 diabetes

Thomson, Hilary J., Ekinci, Elif I., Radcliffe, Nicholas J., Seah, Jas-mine, MacIsaac, Richard J., Jerums, George, and Premaratne, Erosha (2016) Elevated baseline glomerular filtration rate (GFR) is independently associated with a more rapid decline in renal function of patients with type 1 diabetes. Journal of Diabetes and its Complications, 30 (2). pp. 256-261.

[img] PDF (Published version) - Published Version
Restricted to Repository staff only

View at Publisher Website: https://doi.org/10.1016/j.jdiacomp.2015....
 
1


Abstract

Aims Renal hyperfiltration is observed prior to the development of diabetic kidney disease (DKD) in patients with type 1 diabetes (T1DM); however its significance remains uncertain. Longitudinal data were used to investigate the association between measured baseline glomerular filtration rate (GFR) and renal function decline in patients with T1DM.

Methods This study included 142 adult patients with T1DM and ≥ 2 measurements of glomerular filtration rate (mGFR; determined by diethylene-triamine-penta-acetic acid plasma clearance). Median follow up was 19 years. Patients were stratified by baseline mGFR quartile. The relationship between baseline mGFR and rate of renal function decline was assessed using random-effect generalized least squares regression, adjusted for age, duration of diabetes, HbA1c, blood pressure, renin-angiotensin-aldosterone system inhibitor therapy, LDL and BMI.

Results The average rates of decline in renal function for the 2nd (baseline mGFR: 96.4–112.6 ml min− 1 1.73 m− 2), 3rd (baseline mGFR: 112.6–125.5 ml min− 1 1.73 m− 2) and 4th quartiles (baseline mGFR >125.5 ml min− 1 1.73 m− 2) were significantly faster than the first quartile (baseline mGFR: 60.9–96.4 ml min− 1 1.73 m− 2). In further detail, the average rates of decline in the 2nd (rate of decline 1.25 ml min− 1 1.73 m− 2 per year, 95% CI: 0.97; 1.52, p=0.008), 3rd (rate of decline 1.35 ml min− 1 1.73 m− 2 per year, 95% CI: 1.08; 1.62, p= 0.001) and 4th quartiles (rate of decline 1.6 ml min− 1 1.73 m− 2 per year, 95% CI: 1.34, 1.88, <0.0001) were significantly faster when compared to the first quartile (rate of decline 0.67 ml min− 1 1.73 m− 2 per year, 95% CI: 0.37; 0.96). Sub-analysis of quartile 4 revealed higher HbA1c measurements throughout follow-up in those with rapid mGFR decline (> 3.0 ml min− 1 1.73 m− 2/year).

Conclusions In patients with T1DM, higher baseline mGFR is associated with more rapid mGFR decline. Patients with high baseline mGFR who developed rapid mGFR decline had higher HbA1c measurements throughout the study. These findings are consistent with the concept that poor glycaemic control over time may be a determining factor for the rapid renal function decline observed in some hyperfiltering patients.

Item ID: 61521
Item Type: Article (Research - C1)
ISSN: 1873-460X
Keywords: hyperfiltration; kidney; diabetic nephropathy; diabetic kidney disease; diabetes
Copyright Information: Crown Copyright © 2016 Published by Elsevier Inc. All rights reserved.
Date Deposited: 23 Jan 2020 06:24
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110306 Endocrinology @ 100%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920104 Diabetes @ 100%
Downloads: Total: 1
More Statistics

Actions (Repository Staff Only)

Item Control Page Item Control Page